Final Exam Review Flashcards
List the types of evidence used in Evidence Informed Practice
clinical experience
patient’s presentation
research evidence
Clinical experience allows clinicians to develop:
Diagnostic expertise
Clinical motor skills
An understanding of patients needs and preferences
Communication skills
Limitations of clinical experience include:
Reverse gullibility False attribution Out of sight, out of mind Clinicians are not statisticians Fallacy of making hasty conclusions Rose-colored glasses
Advantage of clinical research is _________
Disadvantage of clinical research is _________
usually examines the effectiveness of treatments and diagnostic tests
Not all clinical research is valid, applicable or available.
List principle differences between basic science research and clinical research
Basic science provides foundational understanding of organisms and diseases.
Basic science also provides information that is necessary to develop new tests and treatments. It does not usually produce results that can be directly applied to patients.
Clinical research is most often performed in clinical setting, dealing with human subjects
Compare the outcomes that are measured in basic science research versus clinical research
Basic science - disease-oriented outcomes e.g. cell count, cell change, biochemical markers
Clinical research - patient-oriented outcomes e.g. quality of life, pain level
List types of observational research
Case report Case series Case-control studies cohort studies cross-sectional studies
This type of study identifies an outcome researchers want to know more about (for example Alzheimer’s) and follows people who have developed this outcome. These people are then compared to controls (those without the outcome of interest) to see if there were differences in exposure.
Case control study
This type of study is a detailed description of an interesting or unusual case in clinical practice.
Case report
A cohort study is ________
Start with a “cohort” of people who do NOT have the outcome of interest and follow them for long periods of time to see if they develop the outcome of interest. Data is collected on levels of exposure to different risks.
A cross sectional study is _______
A snapshot of a specific population’s health and behaviors at one point in time.
A case series is ________
Observation of a series of persons without a control group
Quantitative research uses structured methods to describe ________. It is based on the assumption that ____________
an observation or relationship in numerical terms
reality can and should be measured
Most basic science and clinical research is ______ in nature
quantitative
Qualitative research aims to understand ___________. It emphasizes understanding what contributes to ___________
human experiences and discover how people interpret the world around them
peoples’ subjective understanding of reality.
The evidence pyramid is _______.
What part of the pyramid is most valid? why?
a guide to help clinicians judge the relative validity, or quality, of research studies
Summary research is most valid because it synthesizes ALL of the studies (original research) on a given topic which enhances validity
Discuss limitations of summary research
they are never truly up-to-date
results are sometimes difficult to apply to individual patients
Usefulness of Research Source = _________
( Relevance x Validity )/ Work
What is the 6A Process?
Analyze and Ask to help identify and focus questions
Acquire relevant research (summary sources)
Appraise relevance and validity
Apply evidence using clinical experience and patient presentation
Assess patient’s response
Randomized clinical trials generally answer questions about ____________
the effectiveness of treatments
List characteristics of RCTs
Performed in controlled settings
Always include a comparison or a control group
Advantages of RCTs include _________
They can establish cause and effect relationships with a degree of certainty
A prospective approach
The use of concealed allocation in treatment assignment
The use of blinding
Disadvantages of RCTs include _________
In some instances it is impractical, impossible, or unethical to randomly assign patients to an exposure
Lack generalizability
Can’t answer qualitative questions about patient preferences
Can be expensive and time consuming
What are methods of reducing bias in RCTs?
blinding
randomization
random allocation
Internal validity is an indicator of a study’s ability to _______
External validity indicates ___________
answer the question it intended to answer
how well the study was done (minimize bias?)
PICO stands for ___________
Patient/ Problem
Intervention
Control
Outcome
List and define types of research bias
Experimenter Bias - observation bias - experimenter’s expectationg affect measurement of participant’s behavior
measurement bias - systematic error favoring particular result
Sampling bias - systematic differences between groups being compared
List advantages of using outcome measures in clinical practice
Systematically monitoring how your patients are doing
Providing information that helps you make decisions
Setting goals with patients
Demonstrating to your patients how they are doing and helping to explain your treatment decisions
Demonstrating to others (such as insurance companies and other health care providers) how your patient is doing and helping to justify treatment decisions
Communicating results of an interesting case if you decide to write a case report
Assessment of the treatment article/ study. What sections to look at for quick overview of the study?
For determining validity of the study?
For determining why the study was conducted?
abstract
methods
introduction
Compare meta-analyses and systematic reviews
Meta-analyses use statistical analysis to combine the results of original studies (quantitative synthesis)
Systematic reviews provide simple summary of original studies (qualitative synthesis)
Compare Guidelines and Evidence based textbooks
Guidelines address various aspects of broad topics, like health care conditions. They usually address a range of questions including the prevalence of the condition, the tests and procedures used to diagnose it, and how to prevent and treat it.
Evidence based textbooks are a common source of clinical information. They often provide a well-organized consensus of knowledge in a given field.
What are narrative reviews?
Provide simple summary of the studies (qualitative synthesis). Authors have NOT searched for and included ALL available studies on a topic. They do not generally critically appraise the research. Provides authors’ opinions on a topic and so can provide important information that can help you understand key theories and context about health care conditions, treatments, and tests.
List STRICTA recommendations
Acupuncture rationale Needling details Treatment regimen Co-interventions Practitioner background Control interventions
What are the best ways to measure pain in clinical practice?
11-box numerical rating scale
Visual analogue scale
Verbal 0-10 scale
What are tests to measure disability?
LBP -The Roland Morris Questionnaire
LBP - The Oswestry Questionnaire
The Neck Disability Index
What are tests to measure quality of life?
SF 36
Medical Outcomes 36 Item Short Form Survey
EQ-5D
